Estimating Insurance for Flat Fee PPO Plans
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Setting Up Insurance > Handling Insurance Plan Information > Understanding Preferred Provider (PPO) Plans

Estimating Insurance for Flat Fee PPO Plans

The following table explains the insurance estimation calculations used for dental and medical flat fee PPO plans. The calculations show the estimations when the deductible is subtracted first or last.

The insurance estimation calculations used for dental and medical flat fee PPO plans are:

Plan Type

Calculations

Dental Flat Fee PPO Plan

Bluebook Entry

No Deductible

The allowed amount is subtracted from the fee. The difference is the estimated write-off amount. The estimated write-off amount is added to the insurance payment entered in the bluebook.

In the example:In the example:The $75 allowed amount is subtracted from the $88 fee, leaving $13. The $13 difference is added to the $60 insurance payment entered in the bluebook. The estimated insurance payment is $73.

Dental Flat Fee PPO Plan

Bluebook Entry

Deductible Subtracted First

The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. The difference is added to the estimated write-off amount.

In the example:In the example:The $25 deductible amount is subtracted from the $60, leaving $35. The $35 difference is added to the $13 estimated write-off amount ($88 - $75). The estimated insurance payment is $48.

Dental Flat Fee PPO Plan

Bluebook Entry

Deductible Subtracted Last

The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. The difference is added to the estimated write-off amount.

In the example:In the example:The $25 deductible amount is subtracted from the $60, leaving $35. The $35 difference is added to the $13 estimated write-off amount ($88 - $75). The estimated insurance payment is $48.

Dental Flat Fee PPO Plan

No Bluebook Entry

No Deductible

The coverage percentage is automatically multiplied by the fee.

In the example:In the example:The 80% coverage percentage is multiplied by the $88 fee. The estimated insurance payment is $70.40.

Dental Flat Fee PPO Plan

No Bluebook Entry

Deductible Subtracted First

The deductible is automatically subtracted from the fee. The difference is multiplied by the coverage percentage.

In the example:In the example:The $25 deductible is automatically subtracted from the $88 fee, leaving $63. The 80% coverage percentage is multiplied by $63. The estimated insurance payment is $50.40.

Dental Flat Fee PPO Plan

No Bluebook Entry

Deductible Subtracted Last

The coverage percentage is automatically multiplied by the fee. The deductible is subtracted from the product.

In the example:In the example:The 80% coverage percentage is multiplied by the $88 fee, leaving $70.40. The $25 deductible is subtracted from $70.40. The estimated insurance payment is $45.40.

Medical Flat Fee PPO Plan

Bluebook Entry

Deductibles Do Not Apply

The allowed amount is subtracted from the fee. The difference is the estimated write-off amount. The estimated write-off amount is added to the insurance payment entered in the bluebook.

In the example:In the example:The $75 allowed amount is subtracted from the $88 fee, leaving $13. The $13 difference is added to the $60 insurance payment entered in the bluebook. The estimated insurance payment is $73.

Medical Flat Fee PPO  Plan

No Bluebook Entry

Deductibles Do Not Apply

The coverage percentage is automatically multiplied by the fee.

In the example:In the example:The 80% coverage percentage is multiplied by the $88 fee. The estimated insurance payment is $70.40.

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